I remember it like it was yesterday. I found myself on the ground, my shoulder split. I'd gone for a run and fell over a rock since I wasn't paying attention to the landscape. And I went down.
Even now, all these years later, I'm struck by something strange: even though I'd experienced a few tumbles while jogging over the years, I'd never had more than a skinned knee — so why did I fall so hard that time? That got me thinking: why do falls cause more catastrophic injuries as we become older?
The issue with falling
As I researched the relationship between aging and fall-related injuries, I was reminded of a story about an elderly guy who was being assessed for continually falling: "It's not the falling that bothers me — it's the landing." And his response is wise - how we land as children when we trip and fall is significantly different from how we land as adults. One obvious difference is that the distance and force are higher: as adults, we are larger and fall from a greater height. But there's another significant distinction. As children, we frequently "catch ourselves" before landing too hard. A rapid turn of the body, an outstretched hand, or clutching a nearby railing can be the difference between a small scrape and a fractured bone.
Age affects reaction time
It may come as no surprise that our reaction times diminish as we age. Researchers had seen this phenomena in previous studies, but it was recently put to the test again in a more high-tech manner. The study compared reaction speeds of participants aged 25 to 35 to those aged 65 and older using a Nintendo Wii computer system. Each volunteer was required to respond to a visual signal by "hammering" or stepping on a keyboard in front of them. The results were startling: older people had much shorter reaction times.
In addition to slower reaction times, elderly people have weaker coordination and move with less force and speed.
What causes this to happen? It's a combination of age-related brain changes, slowed signals from the brain to nerves and muscles, decreased joint and tendon flexibility, and weaker muscles. Furthermore, older people have a less precise perception of the position of their extremities in space. These alterations increase the likelihood of falling and diminish one's capacity to make quick adjustments if they do fall.
Falls are more than just falls
When an adult falls and sustains an injury, the first priority is to determine the severity of the damage and treat it. That section is usually the simplest (though a hip fracture or a head or neck injury can be disastrous). The following stage may be more difficult: determining why the fall occurred. Stepping onto an icy or uneven sidewalk is an apparent example. However, determining the cause of recurring falls or falls that appear to occur for no apparent reason needs time and judgment. People fall for a variety of causes, including medication, heart difficulties, and nerve illnesses. When a specific reason is established, measures can help prevent future falls.
What options are there?
Clinical studies have found that older people who participate in exercise programs focusing on balance, strength, flexibility, and stamina had a lower risk of falling. Few studies, however, have directly targeted reaction speeds. As a result, it is plausible – but unproven – that faster reaction times can be learned. Perhaps we might use the Wii system mentioned earlier to train elderly people to react faster. If it is achievable, falling may become less common and injuries may become less severe.
Other generally advised strategies to avoid falls and associated effects include:
Exercise- Focusing on balance, strength, flexibility, stamina and hand-eye training.
Education- For example, ensuring that older people understand the dangers of falling so that unnecessary risks (such as standing on a chair to replace a lightbulb) can be avoided—as well as educating people how to prevent such risks.
Making the environment more secure- Clutter cleanup and the removal of loose rugs from the home are two examples.
Vision evaluation- It is critical for older people to undergo a comprehensive eye exam and treatment for any eye problems (such as cataracts) that can impair vision.
Having regular exams and going through all prescriptions- As previously stated, numerous diseases and drugs impair balance and blood pressure, increasing the risk of falling.
Limiting alcohol consumption- Because alcohol affects balance and blood pressure, excessive drinking can lead to falls.
If necessary, use a walker or cane for increased stability.
Increasing bone mass- Calcium and vitamin D supplements, as well as drugs to build bone mass (if necessary), can improve bone strength and reduce the risk of fracture in the event of a fall.
This is the story of Robert H. Shmerling, MD
